Whellan D J, Gaulden L, Gattis W A, Granger B, Russell S D, Blazing M A, Cuffe M S, O'Connor C M
Division of Cardiology, Department of Medicine, Box 3356, Duke University Medical Center, Durham, NC 27710, USA.
Arch Intern Med. 2001 Oct 8;161(18):2223-8. doi: 10.1001/archinte.161.18.2223.
To handle the increasing complexity of congestive heart failure (CHF) care, several new models for the care of patients with CHF have been developed to replace traditional strategies. We undertook this study to evaluate the potential benefit of implementing a CHF disease management program at a tertiary care center, particularly in terms of beta-blocker use and cost to the health care system.
After reviewing the literature regarding therapies and management strategies for patients with CHF, we developed the Duke Heart Failure Program. All enrolled patients had 1 of the following: recent CHF hospitalization, ejection fraction less than 20%, or symptoms consistent with New York Heart Association class III or IV. We compared preenrollment and postenrollment medication use and resource utilization.
We enrolled 117 patients from July 1998 to April 1999. Mean enrollment time was 4.7 months. beta-Blocker use and dose significantly increased (52% vs 76% for beta-blocker, P<.01; 6% vs 13% of target dose, P<.01). The hospitalization rate decreased (1.5 vs 0 hospitalizations per patient-year, P<.01), while the number of clinic visits increased (4.3 vs 9.8 clinic visits per patient-year, P<.01). The Duke University Health System saved a median of $8571 per patient-year.
Implementing a CHF disease management program was associated with improved CHF medication dosing and with decreased hospitalization for patients with CHF. A CHF disease management program is an effective method for a health care system to care for patients with CHF.
为应对充血性心力衰竭（CHF）护理日益增加的复杂性，已开发出几种新的CHF患者护理模式以取代传统策略。我们开展这项研究以评估在三级医疗中心实施CHF疾病管理项目的潜在益处，特别是在β受体阻滞剂使用和医疗保健系统成本方面。
在回顾有关CHF患者治疗和管理策略的文献后，我们制定了杜克心力衰竭项目。所有登记患者具有以下情况之一：近期CHF住院、射血分数低于20%或符合纽约心脏协会III级或IV级的症状。我们比较了登记前和登记后药物使用及资源利用情况。
我们在1998年7月至1999年4月期间登记了117例患者。平均登记时间为4.7个月。β受体阻滞剂的使用和剂量显著增加（β受体阻滞剂使用从52%增至76%，P<.01；达到目标剂量的比例从6%增至13%，P<.01）。住院率下降（每位患者每年住院次数从1.5次降至0次，P<.01），而门诊就诊次数增加（每位患者每年门诊就诊次数从4.3次增至9.8次，P<.01）。杜克大学医疗系统每位患者每年平均节省8571美元。
实施CHF疾病管理项目与改善CHF药物剂量及降低CHF患者住院率相关。CHF疾病管理项目是医疗保健系统护理CHF患者的有效方法。
